Doctors Academy - Breast COPY

Question 1

What is the blood supply to the breast?

Answer 1

Anterior intercostal branches from the internal thoracic artery
thoracoacromia branches
lateral thoracic artery
lateral mammary arterys

Question 2

what are the risk factors for breast cancer

Answer 2

Early menache
late menopause
not breast feeding
atypical breast hyperplasia

Question 3

What does triple assessment compose of?

Answer 3

Clinical examination
Radiological imaging
core biopsy

Question 4

At what age people entered in to the national breast screening program

Answer 4

between 47/53 - 70/73

Question 5

How do you screen patients who are below the age of 40?

Answer 5

do an USS

Question 6

If patients of any age present with a lump, what radiological investigations do you do?

Answer 6

mammogram and USS

Question 7

What 3 factors does the Nottingham prognostic indicator involve? and how is the score calculated?

Answer 7

• Size = 0.2 x size in cm
• Number of nodes
  
  • 0 = 1 point
  • 1-3 = 2 points
  • >3 = 3 points
• Grade
  
  • Grade 1 = 1 point
  • Grade 2 = 2 points
  • Grade 3 = 3 points

you add these all together for a score.

Question 8

what is a poor NPI number?

Answer 8

> 5.4

Question 9

What non surgical treatment can be given to a patient with breast cancer who is ER positive

Answer 9

give tamoxifen for 10 years and then anastrozole

Question 10

what non surgical treatment can be given to a patient with breast canacer who is HER 2 positive

Answer 10

Neoadjuvant Chemotherapy

Question 11

what are the risks of giving tamoxifen?

Answer 11

• increased risk of blood clots
• increased risk of endometrial cancer
• need to monitor LFTs every 6 months

Question 12

What genes are associated with breast cancer

Answer 12

• BRACA
• PALB2
• TP53
• CHD1

Question 13

by what percentage does a mastectomy reduce the risk of breast cancer in a pateint with the BRACA gene?

Answer 13

reduces risk by 90%

Question 14

what are some of the features of phlodes tumour?

Answer 14

• rapidly growing mass
• leaflike architecture
• intra-canalicular growth pattern
• cleft like spaces
• hypercellular stroma
• haematogenous spread

Question 15

When breast cancer metastasises to bone, which bones does it commonly affect?

Answer 15

The axial skeleton

Question 16

which cancers produce osteolytic bone metastasis?

Answer 16

• Breast
• melanoma
• thyroid
• renal cell carcinoma
• lung cancer

Question 17

which cancers produce osteosclerotic bone mets?

Answer 17

prostate cancer

Question 18

What is the manamgnet of fibroadenoma?

Answer 18

• if >40mm consider removal
• if <40mm conservative

Question 19

what are the features of periductal mastitis and what is the treatment?

Answer 19

• May present with features of inflammation, abscess or mammary duct fistula
• Strongly associated with smoking

Treatment: antibiotics and review in 1 week to rule out inflamatory breast cancer

Question 20

what are the features of duct ectasia?

Answer 20

• Patients usually present with nipple discharge, which may be from single or multiple ducts (usually present age >50 years
• The discharge is often thick and green

Question 21

what is the treatment of breast abscesses?

Answer 21

USS guided drainage

NB: patients can continue to breast feed

Question 22

how do you assess a patient for susspected breast cancer if they are pregnant?

Answer 22

• Mamogram with fetal shielding
• x ray + USS
• Core biopsy

Question 23

what is the treatment of breast cancer in a pregnant patient

Answer 23

1. Mastectomy or WLE - do any operation after the first trimester
2. Radiotherapy after delivery

If the patient needs chemotherapy this can be done after the 1st trimester

Question 24

which patients require a breast MRI

Answer 24

• Prior to neoadjuvant chemotherapy
• patients with BRACA genes
• Ptients with strong family history of breast cancer
• patients presenting with a lump + have breast implants
• any patient where there is incongruity between USS and assessment??

Question 25

what other cancer are males and females at risk of developing if they have BRACA gene?

Answer 25

Males = Prostate

Females = Ovarian

Question 26

Which patients require neoadjuvant chemotherapy?

Answer 26

• Large tumours (>5cm)
• locally advanced
• positive axillary lymph node
• ER -ve, HER 2 +ve

Question 27

What are the indications for adjuvant chemotherapy

Answer 27

• HER2 +ve
• Tripple -ve
• Axillary node +ve

Question 28

what are the indications for radiotheraphy

Answer 28

• WLE / mastecomy
• Axillary node +ve with mastectomy

Question 29

what is the most important prognostic factor in breast cancer.

Answer 29

nodal status

Question 30

what are the features of intraductal papiloma and what is the treatment

Answer 30

• single duct discharge.
• The fluid is often clear, although it may be blood stained.
  
  • If the fluid is tested with a labstix (little point in routine practice) then it will usually contain small amounts of blood.

Treatment: A microdochectomy may be performed.

Question 31

what should you do if the imaging and biopsy results are not concordant

Answer 31

either MRI or WLE

Question 32

What is the treatment for duct ectasia

Answer 32

Hadfields procedure

Question 33

What is the most common hormonal status in women with breast cancer

Answer 33

Oestrogen and HR2 negative

Question 34

Comedo necrosis + calcifications are signs of which form of breast cancer?

Answer 34

DCIS